Cardiovascular Mortality Gap Between the United States and Other High Life Expectancy Countries in 2000–2016
Open accessAbstract
Objectives: Reductions in U.S. cardiovascular disease (CVD) mortality have stagnated. While other high life expectancy countries (HLCs) have also recently experienced a stall, the stagnation in CVD mortality in the United States appeared earlier and has been more pronounced. The reasons for the stall are unknown. We analyze cross-national variations in mortality trends to quantify the U.S. exceptionality and provide insight into its underlying causes. Methods: Data are from the World Health Organization (2000–2016). We quantified differences in levels and trends of CVD mortality between the United States and 17 other HLCs. We decomposed differences to identify the individual contributions of major CVD subclassifications (ischemic heart disease [IHD], stroke, other heart diseases). To identify potential behavioral explanations, we compared trends in CVD mortality with trends in other causes of death related to obesity, smoking, alcohol, and drugs. Results: Our study has four central findings: (a) U.S. CVD mortality is consistently higher than the average of other HLCs; (b) the U.S.–HLC gap declined until around 2008 and increased thereafter; (c) the shift from convergence to divergence was mainly driven by slowing IHD and stroke mortality reductions and increasing mortality from other CVD causes; (d) among the potential risk factors, only obesity- and alcohol-related mortality showed age-specific temporal changes that are similar to those observed for cardiovascular mortality. Discussion: The exceptional changes in U.S. CVD mortality are driven by a distinct pattern of slowing reductions in IHD and stroke mortality and deteriorating mortality from other CVD causes. Obesity and alcohol abuse appear to be interrelated factors.
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The mortality benefits from the rapid decline in cigarette smoking levels may be diminishing.
“The mortality benefits from the rapid decline in cigarette smoking levels may be diminishing (42, 43).”
From Insights into US life expectancy stagnation from birth cohort mortality dynamics (2026) · cites this paper as [42]
In the Discussion, under “The Role of Risk Factors” (page not provided), the paper describes diminishing benefits from declining smoking as a hypothesis, then explicitly rejects it. It reports that decreases in smoking-related mortality accelerated and suggests that declining smoking may still contribute to CVD mortality reductions. (LLM, conf=0.90)
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- Authors
- Acosta, E., Mehta, N., Myrskylä, M., & Ebeling, M.
- Affiliations
- Max Planck Institute for Demographic Research (DE)
- The University of Texas Medical Branch at Galveston (US)
- University of Helsinki (FI)
- Karolinska Institutet (SE)
- Corresponding author
- Acosta, Enrique
- Venue
- The Journals of Gerontology: Series B
- Publisher
- Oxford University Press (OUP)
- Published
- 2022-02-23
- Volume
- 77
- Issue
- Supplement_2
- Pages
- S148-S157
- ISSN
- 1079-5014 (ISSN-L)
- 1758-5368
- PMC
- PMC9154236
- OpenAlex
- W4210947903
- Cited by
- 29
- References
- 45
- Citations by year
- 2026: 8 · 2025: 8 · 2024: 8 · 2023: 1 · 2022: 4
- FWCI
- 3.79
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- The Journals of Gerontology Series B (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- Funders
- National Institute on Aging (P30AG012846, P30AG024832)
- Social Sciences and Humanities Research Council of Canada (756-2019-0768)
- Topics
- Health Sciences › Medicine › Epidemiology › Healthcare Systems and Public Health
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
- Social Sciences › Demography › Insurance, Mortality, Demography, Risk Management
- Keywords
- cardiovascular mortality, mortality trends, ischemic heart disease, stroke mortality, obesity, alcohol-related mortality, smoking, drug-related deaths, cross-national comparison, age-specific mortality
- MeSH terms
- Cardiovascular Diseases, Humans, Life Expectancy, Obesity, Risk Factors, United States, Stroke
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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